Provider Demographics
NPI:1053452458
Name:PAUL, SCOTT R (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:R
Last Name:PAUL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 LAWN ST
Mailing Address - Street 2:
Mailing Address - City:ROXBURY CROSSING
Mailing Address - State:MA
Mailing Address - Zip Code:02120-3353
Mailing Address - Country:US
Mailing Address - Phone:617-549-8609
Mailing Address - Fax:
Practice Address - Street 1:340 WOOD RD
Practice Address - Street 2:SUITE 301
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-2401
Practice Address - Country:US
Practice Address - Phone:781-356-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPENDING208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics